INFECTION DIAGNOSTICS :: VIROLOGY TESTING


individualized attention to test results as clinicians confront novel effects of aging with HIV as well as drug therapies taken for several decades. Even with successful viral suppression and barring side-effects, HIV infection is associated with accelerated aging and increased rates of cardiovascular, renal, neurocogni- tive, oncological, and osteoporotic disease.2


Yet, viral suppression


is also critical to avoid transmission and new infections. National efforts to limit the transmission of HIV include am-


bitious new programs such as the Ending HIV Epidemic (EHE), which sets the goal at fewer than 3,000 new infections per year beginning in 2030.3


Antiretroviral treatment has proven highly


effective in maintaining non-transmissible VL for HIV-infected individuals and pre-exposure prophylaxis (PrEP) has shown ex- ceptional results in preventing infection among at-risk patients.4 To achieve the ambitious EHE objectives, the Centers for Disease Control and Prevention (CDC) recommends substantially in- creasing both antiretroviral treatment and administration of PrEP.5


Local laboratories more intimately involved with patients


are the ideal venues to provide regular testing, diagnosis, and VL monitoring with highly sensitive and reliable assays, and in turn ensure patients are quickly linked to the appropriate care for prevention or intervention.


In an effort to combat an increase in new HCV infections, the CDC Division of Viral Hepatitis, in cooperation with the Association of Public Health Laboratories (APHL), provided grants to support laboratories in at least 12 states seeking to add or expand HCV testing.6


Left untreated, HCV infection can


become chronic in approximately 50% of patients, and nearly a fifth of those patients will develop serious morbidities including progressive liver fibrosis, cirrhosis, and liver cancer.7 Fortunately, HCV infection is curable in more than 90% of patients who receive timely treatment,7


Clinical laboratories faced unprecedented challenges throughout the pandemic, but it is time to make good use of these past experiences and move on to new challenges.


Now, we envision similar success as we move all VL testing from the molecular virology lab to cytology, where personnel already have experience running HPV, chlamydia, gonorrhea, and trichomoniasis assays. Many of our techs, already familiar with similar instrumentation,


are in the perfect position to acquire the expertise necessary to become bona fide molecular techs—which in our lab means learn- ing to troubleshoot quantitative assays. As these techs advance and become key advisors to clinicians, the rewards for their career, our lab, and ultimately for patients, will be very gratifying to see.


Conclusion


Clinical laboratories faced unprecedented challenges through- out the pandemic, but it is time to make good use of these past experiences and move on to new challenges. The lessons learned and technologies acquired can be used to seamlessly transition to address current and growing clinical needs—ful- filling the mandate to curtail HIV and HCV transmission and disease; engaging bright talent in the 21st century pathology laboratory; and continuing to cultivate in-house testing and local hospital resources to benefit our patients and to improve healthcare worldwide.


which again places lab-


oratory testing at the forefront—especially because both new and chronic HCV may be asymptomatic. The ideal candidate to coordinate these efforts is the local hospital laboratory where testing can be performed closer to the patient, where test results can be available in hours instead of days, and where clinicians can consult with pathologist colleagues to guide the often nuanced treatment decisions. For instance, because HCV shares corresponding risk factors with HIV, concurrent screening may be recommended, and many emergency departments around the country automatically screen for both infections unless the patient opts out.8


The local laboratory that can run these assays


with a single sample, return accurate results quickly, and consult directly with clinicians will foster a better patient experience and better care. HIV and HCV present unique challenges as life-threatening viral infections that many at-risk people avoid confronting due to persistent stigmas throughout various segments of society. We stand a greater chance at achieving the national infection reduction targets when patients feel supported by their health- care team. Keeping testing local with in-house capabilities can play a significant role in the lives of people living with HIV. Reliable laboratory test results keep patients informed on their viral suppression and CD4 count, minimize follow-up visits, and reduce the anxiety caused by extensive turnaround times.


VL testing is an essential skillset worth developing Within the laboratory, we are also very excited about making the most of our new capabilities to further develop the knowledge of our highly skilled staff. In the past, when we could not hire off the market, we created our own histology school as a one-year program, and many bright, motivated candidates who started as unlicensed lab aids, became full-time, licensed histology techs.


28 | SEPTEMBER 2023 MLO-ONLINE.COM REFERENCES 1. Data on File. ACL Laboratories.


2. Wing EJ. HIV and aging. Int J Infect Dis. 2016;53:61-68. doi:10.1016/j. ijid.2016.10.004.


3. Ending the HIV Epidemic. HIV.gov. Accessed June 12, 2023. https://www. hiv.gov/federal-response/ending-the-hiv-epidemic/overview/.


4. Prevention. Cdc.gov. Published February 2, 2023. Accessed July 17, 2023. https://www.cdc.gov/hiv/basics/prevention.html.


5. EHE progress. Cdc.gov. Published June 8, 2023. Accessed July 17, 2023. https://www.cdc.gov/endhiv/ehe-progress/index.html.


6. Expansion of hepatitis C virus (HCV) nucleic acid testing (NAT). APHL. Accessed July 17, 2023. https://www.aphl.org/rfp/Pages/HCV-NAT.aspx.


7. What is hepatitis C - FAQ. Cdc.gov. Published February 11, 2022. Accessed July 17, 2023. https://www.cdc.gov/hepatitis/hcv/cfaq.htm.


8. Newsom Governor G, Aragón TJ, Jacobson K, Ramos M. State of Cali- fornia—health and human services agency. Cdph.ca.gov. Accessed July 17, 2023. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Docu- ment%20Library/DCL-Opt-Out-ED-HIV-HCV-and-Syphilis-Screening.pdf.


Sonia Benhamed, PharmD, SMB(ASCP) is Executive Director of Genetics at ACL Laboratories. She is a laboratory expert with over 20 years of experience in leading genetics laboratories.


Dr. Michael Mihalov is Medical Director of the ACL Illinois Central Laboratory in Rosemont, Illinois, which performs all molecular testing for the Advocate Healthcare system, including over 42,000 HIV and HCV viral load tests since 2020. He previously established clinical molecular pathology laboratories at University of Illinois, Chicago (UIC) and Resurrection Medical Center (now AMITA). He lives on Chicago’s Magnificent Mile with his wife Jackie Sieros, MD,


the grateful recipient of an HCV-positive renal allograft – an infection successfully eradicated with antiviral therapy and timely HCV viral-load testing.


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